Provider First Line Business Practice Location Address:
209 N 4TH ST
Provider Second Line Business Practice Location Address:
UPSTAIRS AND REAR ENTRANCE
Provider Business Practice Location Address City Name:
HIGHLANDS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-526-3241
Provider Business Practice Location Address Fax Number:
828-482-9019
Provider Enumeration Date:
11/01/2013